Don’t Let Just Anyone Touch Your Occlusion

Grinding or clenching of the teeth is a very common problem. It is a nasty problem for its bearer as it causes pain in the muscles and in the jaw joint, headache, toothache and even disturbed sleep at night. If nothing is done to the problem the teeth will eventually suffer from the grinding especially if the occlusion is imbalanced. There will be a recession in the gum, worn enamel, chipped enamel and periodontal problems to start with.

So if you do know that you grind or clench your teeth at night – or even more so if you clench your teeth during the day which is a definite sign that you do it also at night – go to see your dentist. But here’s an important advice:

Do not go to see just any dentist. Find a specialist in that has done 3 extra years of stuyding to gain the title prosthodontics (even better if one has a PhD).

Why? I will tell you the reasons from my own experience.

My First Mouth Guard Or Should I Say Bite Block

I am a dental professional and in my early career I was quite naive and thought that all the dentist can do all the stuff they are taught at school. I was so wrong.

In my first year after graduation I had a bite guard made by a regular dentist in my practice. I soon realised it wasn’t perfect and sought help from a specialist in prosthodontics who was working in our practice.

The first thing the specialist did was that he filed away about 0,7 cm (0,28 inches) of the hight of the bite guard without fitting it in the middle of the filing. Once he was done with the filing he started to adjust it to my occlusion. He was covered with acrylic dust and he did lots of eye rolling and head shaking.

He told me that the bite guard is not ideal and it would be better to have it redone. I never really used it after that and I carried on suffering from the grinding and clenching of the teeth.

My Second Mouth Guard – When Desperate You Accept Anything

Couple of years later I lived in another country and once again sought help from a dentist for the grinding. She recommended me an anterior night guard (also known as NTI or MCI) which she did routinely for every patient suffering from grinding.

Now I tried to find you a web site that had a photo and impartial info about anterior night guard but wasn’t able to find one. So I took a photo of mine. I must apologise that the device is not in a mint condition anymore. There is my current mouth guard (that I will tell you more about later in this post) in the photo for comparison.

NTI/MCI/anterior night guard on the left

I felt this anterior night guard – I will call it MCI from now on – relieved the symptoms I had. I was very happy about the dentist and the MCI. Until I spoke to a former colleague of mine, a very good dentist.

He warned me that I was in risk of developing an anterior open bite due to a use of MCI. I did not second guess him once he explained the reasons.

With MCI the back teeth do not make contact. And when the teeth don’t make a contact with the opposite side they will erupt while the front teeth are kept in place by MCI. The over-erupted back teeth cause the open bite in the front. Simple as that.

We’ve all seen what happens to a tooth that lacks an opposing partner in occlusion. It over-erupts!

So I got an advice to use the MCI for 2 weeks and then keep 2 weeks break to avoid the over-erupting back teeth. So I did. But it did not keep the symptoms of grinding at bay.

My Third Mouth Guard Was Almost What It Should Be

Five years later I was back in my home country where I was advised to have a mouth guard done by a dentist in my practice. I did and she removed my upper wisdom teeth so that it was easier to have the mouth guard done. Once I received the mouth guard I didn’t feel it was helping me at all.

At this point I had had enough of the dentists in this matter and decided to see a specialist in prosthodontics. One that was known to be a good one.

The specialist did a careful examination on my teeth and the mouth guard. He said the mouth guard was ok’ish and that he just needed to adjust it. I also showed him my MCI which he advised to use only as emergency basis and only 4-5 days in a row.

I told to the specialist that I have a feeling that only my last molars were in contact. He checked it and said there was no imbalance – meaning that my bite was as it should be. I also asked if I should do the exercise for the jaw muscles. The specialist said there is no benefit of it.

I had to return to see the specialist every 6 months and every time he adjusted the mouth guard and charged quite a lot even compared to the specialist’s fares.

After 3 years of using the mouth guard there was a hole in it. I had apparently “bitten” through it. It was time to have a new mouthguard done.

My Fourth And Current Mouth Guard

For one reason or another I did not completely trust the specialist I had been seeing so I asked for recommendations of specialists from my colleagues. Based on the recommendations I went to see a specialist in prosthodontics and stomatognathic physiology – she had PhD too!

I was kinda shy when mentioning that I have a feeling that only my last molars were in contact – well hell yeah, one specialist had told me I was imagining things.

Only this time I was told I was right. She also told me that I have a partial anterior open bite. I was flabbergasted. I knew that not all the dentist master the matters of occlusion but even the specialists get it wrong!

And once she had done her magic about my occlusion by balancing it I felt the difference immediately.

By the way – my intact upper wisdom teeth were unnecessarily removed by the dentist who made my third mouth guard. A mouth guard can be done with the wisdom teeth in place as long as they are nicely positioned as mine were.

So after I had my occlusion sorted out I got my new bestest of the best mouth guard. It is amazing I must say. It brought me an immediate relief. But I was only half way through the treatment.

I was booked to see a dental hygienist who did massage for the muscles of the jaw in 3 separate visits and gave instructions (based on the specialist’s recommendations) on how to exercise the muscles by stretching and strengthening them. I realised that having a mouth guard is not enough. It won’t take away the root cause of the grinding which in my case was the weak muscles that did not support the jaw.

The MCI I was not allowed to use again. I did not argue with that.

Conclusion

I, a dental professional had three mouth guards (including the MCI) done until I got a proper one. None of the dentists I saw for the mouth guard had a clue about occlusion or what is the best treatment for it. The second specialist was only concentrating on the mouth guard and did not find the imbalance in my bite. Naughty naughty. I guess he was concentrating in money making – I sense these things as I am HSP – and that was probably one reason I didn’t go back to see him.

I worry over the patients who do not have an understanding of what is right treatment for grinding and clenching of the teeth. There are lots of people using MCI every night and they have been using it for years and years. Do they realise that the open bite they have developed is caused by the use of MCI? No they don’t as the dentist won’t necessarily tell them – especially if the patient is seeing the same dentist who recommended the MCI (see my previous post about this phenomenon). And it is not guaranteed that another dentist will tell either.

Also very commonly the treatment dentists offer for the grinding is the mouth guard. And only the mouth guard. But that is never enough! The best thing any dentist can do for the patient who is suffering from the grinding is to REFER to a specialist.

Important information for the patients: You can make a self referral to a specialist by simply booking an appointment. They will not say no to the new patients. Be prepared to pay more for the mouth guard but it is money well spent.

The occlusion is a delicate thing. I always advice patients not to let just anyone adjust the bite. It can go from bad to worse. You are in better hands when seeing a specialist in prosthodontics. The higher educated one the better – in any health matter.

I learned my lesson the hard way. I suffered from the grinding for many years. I lost two intact wisdom teeth unnecessarily. And I can’t help but think that the malocclusion on my back teeth and the partial anterior open bite were caused by the MCI. There was a dreadful moment when the specialist was thinking that I might need crowns for my intact canine teeth to fix the open bite and to get enough support for the side movements of the jaw. So I can count myself as lucky that the malocclusion could be fixed by simply filing the teeth.

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What do you mean by over-eruption of molars? I have worn an NTI nightguard for many years, and perhaps it’s more than a coincidence that my two of my molars have cracked and broke. One had to be pulled, and the other needed a crown after it broke.

Dear Ronald, sorry for late reply.
Over-eruption means that if the opposing teeth (upper-lower) are not in contact when biting teeth together, these teeth will keep on erupting. Same happens if the opposing tooth is completely missing. When you wear NTI nightguard, it covers only the front teeth. These front teeth have something they are biting on whilst wearing the NTI. But the back teeth don’t. So they keep on growing (over-erupting). If you use the NTI regularly for long period of time the over-erupted back teeth will meet first when biting teeth together and it might be that the front teeth are not in contact at all (=anterior open bite). This can be checked with a thin paper/foil – put the thin paper/foil on top of lower front teeth and bite BACK teeth together. If you can pull the paper out without it breaking, you have an open bite (teeth are not in contact when biting teeth together). Open bite means the back teeth are bearing all the force from the bite when ideally it should be spread evenly between all the teeth. This may lead to microfractures, receding gums, abfractions etc. Sometimes they might even crack and need to be removed.

I also want to share a couple of things I’ve learned along the way about grinding/clenching. First, the connection between grinding/clenching and sleep apnea (or even sleep hypopnea). The link for this is here: https://askthedentist.com/night-guard-grinding/ Also here: https://askthedentist.com/sleep-apnea-grinding-reason/ The basic idea is that teeth grinding and clenching is often caused by sleep apnea and snoring. Clenching the muscles and moving the jaw is the brain’s way of opening up an obstructed airway so we can take a breath while sleeping.
Second, if this is true, can you do anything about snoring and apnea? Tongue and jaw exercises have been very helpful for me. Many people charge for them, but you can find them for free on YouTube. Here’s the best one I know: https://www.youtube.com/watch?v=zIJysIYGbLc After a few weeks of doing this my snoring and apnea went down (less of that dry, sore throat feeling and bad breath in the morning). And my grinding went down as well. To anyone with grinding/clenching issues I recommend trying these exercises for a month to see if they help you. Another thing that helps is the cork exercise to release jaw tension: https://www.sharecare.com/health/types-exercise/relieving-jaw-tension (I’m not an expert, but it seems to me the Kois Depgrogrammer does the same thing at an $800 price tag – am I right?).

Well exercise was the thing I was advised to do by prosthodontist. Went to couple of visits to learn them. I think many grinding/clenching could be fixed if people would exercise their masticatory muscles. About the exercises you referred – whatever makes you feel better is worth doing. And it is a bonus that you save money while doing it. If you notice any worsening of your situation, then you know to stop the exercises.

Thank you for your post! It validates my experience with the same issue. A general dentist made a night guard for me for grinding and clenching about 15 years ago. I wore it regularly over the years, and lo and behold now I have a partial anterior open bite. The guard is on the upper teeth and covers up to tooth #6 on each side. I didn’t notice anything until this year one of my wisdom teeth broke from chewing and had to be removed. After seeing multiple general dentists, I saw a prosthodontist almost by accident and he explained the situation to me, especially the over-eruption. But I still have a big dilemma. The prosthodontist sent me to an orthodontist, claiming I should have orthodontics for the open bite. I’ve seen multiple ortho specialists this year, each of which told me something different. The first was ready to charge me almost $8,000 for Invisalign. The second said, “You don’t need orthodontics for your condition. Your NG pushed out your front teeth. Just leave things as they are and it might fix itself in a year or two.” The next said “You don’t need ortho. I’ll take out all of your other wisdom teeth because they are over-erupted. That will fix everything.” Another said “Here’s a Kois Deprogrammer. Wear this, then I’ll adjust your bite by filing down or adding little bits of material.” I’m still deciding what to do. My problem is that I have a crooked bite on the left side (just the last 2 molars are making contact) and it makes the whole area inflamed and painful to chew. Ortho is out of the question, but I have this dilemma: Do I take out all the other wisdom teeth? If they have over-erupted and are keeping my bite from closing properly, surely it makes sense to get rid of them. On the other hand, what if the real problem is not over-eruption of the molars but rather the front teeth being pushed out by the nightguard? If that’s the case, maybe just waiting is the best option. If so, do I get a bite equilibration in the meantime? This seems like the most conservative option, but I still wonder if taking out the wisdom teeth won’t solve the problem once and for all. Or maybe the wisdom teeth can be filed down instead of taken out? Any input on this would be very helpful. Is there some way to test objectively exactly what’s the problem with my bite (molar over-eruption vs. front teeth pushed out vs. both) before making a decision? Thanks again.

Hello Alex! Thank you for trusting me with your problem. Of course it is difficult to tell for sure what would be the best thing to do without examining your teeth, but there is never really harm having the wisdom teeth taken out. It is actually a very good indication to take them out if they are overerupted. People do not need wisdom teeth really. Especially if you have full dentition (no other than 1 wisdom tooth taken out). I’d say you can safely go for that treatment. And then you may wait and see if things settle. Somehow it doesn’t sound right that a night guard that covers from tooth #6 to other side’s #6 would push just the front teeth out. If it was the case wouldn’t it push all the 12 teeth towards front and leave a gap between #6 and #7 on both sides? Again, difficult to say without seeing. Are you sure you didn’t have open bite already 15 year ago? As I said in my post, I have an open bite from upper #3 to other side #3. It is not that severe open bite which means it does not affect e.g. biting food. It does not need to be fixed as long as I use my night guard. If your teeth wont settle after the wisdom teeth are taken out, then the equilibration sounds ok as long as it is a prosthodontist that performs it. Hope this was helpful! Do not hesitate to ask more.

I am sorry for the late reply. The best thing for you to do is to book a consultation with two different prosthodontist in two different practices. I found one practice that is specialised in prosthodontics. Here’s a link to their website https://www.bostonprosthodontics.com/prosthodontist

Great post. I’ve been using an MCI for the past few years and have developed an open bite. My dentist seems pretty knowledgeable about this; he has recommended filing down a couple molars and moving to a TMJ for sleeping (one that covers all teeth, including back molars). I’m a little nervous about filing down the back teeth, but I don’t know what else to do. He did a 3-D print of my teeth and identified the areas causing problems, so I think he knows what he’s doing. Do overerupted teeth ever resolve on their own? i.e. if I didn’t get filing done and just moved to a TMJ at night, would my bite eventually correct itself?

Thank you for sharing your story. I am happy to answer your questions. Firstly, the open bite won’t resolve by itself. The TMJ (splint/mouth guard/bite plate) that covers all the teeth will protect your teeth from harmful effects of the grinding/glenching. But the open bite remains if nothing else is done. My situation was pretty much the same but the specialist said there would be an option for filing down (we rather call it adjusting the bite) the teeth. This would mean increasing vertical height of relevant (for ideal occlusion) front teeth by crowns. That would mean filing those teeth to abutments. All my front teeth are intact so idea of loosing a lot of healthy tooth structure so that crowns can be made, wasn’t appealing. Crowns are also expensive. So I decided to go for the bite adjustment to see if that would solve the open bite. Mind you, there was still a chance that the adjustment would not fix the open bite and the crowns would be needed anyway. But in my case adjusting the bite was enough and I wear splint every night. I haven’t seen your teeth so cannot absolutely guarantee it, but normally there is quite thick layer of enamel occlusally and when the dentist adjusts the bite he will proceed litlle by little and the amount he files down is in micrometers. Hope this was helpful! Please do not hesitate to ask more if something comes up.

Just having a quick read. This is really interesting! I have a patient at the moment who I have study models for and I am looking to reorganise is occlusion under the guidance of a Professor – the amount of knowledge it requires I can totally appreciate your opinions! Will always bear this in mind!